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Home My WebLink About6633-z lTO~m NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N; Y. BUILDING PER. iT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6633 Z Permission is hereby gran~ted to: .............. i~s.tt ~Lt~m.k .............................. :. .......... ......... ~....s..:.~ .,..?..z:..o,~ ~ .t,:¥... ~.~ ......................................................................................................... at premises located at ...... .~/~..R',,~kelbe.~r~'.. }L~'t3...~o~.~ ..... ~,P2LD...~. ......... ) ......................... ...................................................... .~.~.a.~...~::~.q~ ....... .~;..,.~., ............................................................... pursuant to application dated ..........................~TLtt~e .......... ~. ....... , 19~..., and approved by the Building Inspector. Fee $."J. %..OD. ........... ..... [:.%mL~.'..:.~.:.~....~.~. .......... ../. .......................... Building Inspe~6r ~.. C~ TOWN OF SOUTHOLD ! ~ ~ ~' ~< I ~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .... ........... .......... D~sapproved a/c ........................................................ , ............................. ~ * APPLICATION FOR BUILDING PERMIT ........... ...................... INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or ~n ink and submitted in triplicate to the 13uildin., Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets o areas, and giwng a detailed description of layout ofproperty must be drawn on the diagram which is part of this application c. The work covered by th~s application may not be commenced before ~ssuance of Building Permit d. Upon approval of this apphcat~on, the Building Inspector will ~ssue a Building Permit to the apphcant. Such permi shall be kept on the premises available for inspection throughout the work. e. No build~ng shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupanc; shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o. Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply w~th all apphcable laws, ordinances, building code, housing code, and regulations, and admit authorized ~nspectors on premises and in buildings for necessary inspections ~(S~gnature of apphcant, or'~ame, if ~;poration) · .............................. State whether opphcant is owner, lessee, agent, architect, engineer, general contractor, electnc~an, plumber or builder. Name of C'/owner of premises .~?.~....~~:~.. ................ ..?/.'~.~:T. ...... ...~...~... '~'..~ ........................................... If op~:tnt/ o corp,~te,~l~oture, of duly authorized officer. ............. ~" ' ~ (Nome-)Gnd t~tle of corporate officer) Builder's bcense No .................................................... Plumber's License No ................................................ Electrician's License No ............................................. Other Trode's License No .......... :. ................................... 1 Location of land on which.proposal wo~ ~411 be done. J~4a~i'-J~ ..................... ,~.. ........... Lot No ........................ Street and Number ../~/~~_ ....../~~ ...... ~"~~'"',//~'~'~(~"'~"~"'x"/~'~'~, ............. ~7' Municipality 2. State ex~sting use and occupancy of premises and in'.ended use and occupancy of proposed construction: a. Exisiting use and occupancy b Intended use and occupancy ......................................................... ~. ........................................................ 3. Nature of work (check whtch applicable) New Building .................. Addmon ................ Alteration ..... Repair .................. Removal .................. Demolitian ................... Other Work ...... /~',~,,J::;~.~ ....... ~.~ (Description) 4. Estimated Cost .............................................Fee .... /....~....::...~/.~ .................................................. (to be paid on filing this application) 5 If dwelling, number of dwelhng units ...................... Number of dwelling umts on each floor ................. If garage, number of cars .......................................................................................................................... 6 If business, commercial or mixed occupancy, spemfy nature and extent of each type of use ..................... 7 Dimensions of existing structures, if any: Front .......................... Rear ................................ Depth ................. Hmght ........................ Number of Stories ......................................................................................... D~mensions of same structure with alterations or additions. Front ................................... Rear ... Depth ................................ Height ........................ Nu.m~r of Stories ............................... 8. D,mensions of ent,re new construct,on' Front ..... ~..~...~ ................... I<earj.~L~......~.-/'~ ...... ~..i~.. Depth .~ ./.~T'~--~ Height .................... Number of Stories ................................................................... 9 S,ze of lot. Front ...... c:~..~...~... ................................. Rear .../..c;~.~;;~. ..................... Depth. ~.~...~ ............. 10. Date of Purchase .................................................. Name of Former Owner ............................................ 11 Zone or use dtstrict in whtch premtses are sttuated .............................................................................. 12 Does proposed construchon wolate any zomng law, ordinance or regulation .~ ......................................... 13. Will lot be regraded ............................ Wtll excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises .................................................. Address ................................ Phone No ...................... Name of Architect ...................................................... Address ................................ Phone No ..................... Name of Contractor ....................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly ali buddings, whether ex~stmg or proposedt and indicate oil set-back dimensions frorr property lines. Give street and block number or description according to deed, and show street names and ind,cat, whether interior or corner lot ~/~ . being duly ~worn, deposes and soys that he Js the apphcan~ .............................. ......... of said owner or owners, and ~s duly authonzed to perform or have performed the sa~d work and to make and this apphcat~on; that all statements contained m this apphcation are true to the best of his knowledge and behef; ant that the work will be performed m the manner set forth m the application filed therewith Sworn to before me this JUDITH T BOKEN Noraw PubJm, State of New York N~. 52-0344963 Suffolk Count~~ Commission Exptres March 30, 19~~ Examined Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c .... ~.-..-~ ......................... ...... : ....... ........................... ............. r../: ..................... a. Thi~ apphcation m~st be completely fdleg in by ~pe~riter o~ in mk and s~bmitted in triplicate to lk~ ~uildin, Inspector, with ~ sets of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buildings on premlse~, relatlonski~ to adjoining premises or public streets o areas, and gmng a detailed description of layout o{prope~ must b~ dra~n on ~he d~agram ~kich ~s p~rt of this apphcation c. The work covered by this application may not be commenced before issuance of Budding Permit. d Upon approval of this application, the ~ui[ding Inspector w~ll ~ssue a Building Permit to the applicant. Such permi shall be kept on t~e premises availakl~ for inspection throughout the ~ork, ~. No building shall be occupied or used in whole or in part for any pu~os~ whatever until a Certificate of Occupanc' shall haw been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th, Bu~ld,ng Zone Ord,nonce of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all applicable lows, ordinances, budding code, housing code, and regulations, and t, admit outhonzed inspectors on premises and in buildings for necessary inspections. / (S~gnoture of opphcont, or nome, if o ~o~porotion) / "' '' '' '"' (Addr~ss~/a~ii~'~i-- .............................. Statezs__wh, ether ap_.~licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ........... ::z: ..... :;..~r..:.3 ...... ;....3 .................................................................................................. If app),cc~t ~s a co~or~e, s,g~ature, of duly authorized officer. (Name /,nd t,tle of corporate officer) Builder's bcense No ..................................................... Plumber's License No ................................................. Electriciar~ L:~ceq~ No ............................................ Other Trade's License No ............................................... 1 Location of land on which proposgd worJ~ ~,ill be done. Ma~lxJ~ ..................... .~ ............... ,Lot No ........................ Street and N umber ./Z .~,,~J~....~~ ...... :'~"~"'~"'"~'"'/~"~¢~---'*~' 7'/~u~i' i~ii~'~ ....... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ........................................................................................................................ b. Intended use and occupancy .............................................................................................................................. ~ature of work (check which applicable) New Building .................. Addition ................. Alteration .... Repmr .................. Removal .................. Demolition ................... Other Work .... ~ ........ (Description) 4 Est,mated Cost ~~.. .... .......................................... Fee ...Z..~...~.--~.. ............. (to be paid on filing this appl~cahon) 5 If dwelling, number of dwelhng umts ....................... Number of dwelhng umts on each floor .~ ................. If garage, number of cars ............................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ................ 7 D~mensions of existing structures, if any: Front .......................... Rear ................................ Depth .............. Height ........................ Number of Stories ............................................................................................... D~mensions of same structure with alterations or addmons: Front ................................... Rear ........ Depth ................................ Hmght ......................... Number of Stories ............................ 8. Dimensions of entire new construction' Front.~...)..... ~ear'J.~'....: ................ Uepth".~ ' ~' Hmght .................... Number of Stories ................................................................ 9 S,ze of lot' Front ....... ~.....~.~... ................................. Rear .... ~.~,.~ ......................... Depth .....~..//.~;;;:.~ ....... 10 Date of Purchase ............................................... Name of Former Owner ..................................... 11 Zone or use district in wbch premises are s~tuated ....................................... ~ .............................. 12 Does proposed construction v,olate any zoning law, ordinance or regulation ..................................... 13 W,II lot be regraded ............................ W~II excess fill be removed from premises. ( ) Yes ( ) No 14. Name of Owner of premises ................................................. Address ................................ Phone No ...................... Nome of Architect ..................................................... Address ................................ Phone. No ...................... Name of Contractor ......................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~st!nctly all buddings, whether ex~sting or proposed, and ind,cate ail set-back dimensions fror~ property hnes. Gwe street and block number or descnphon according to deed, and show street names and ind~cat~ whether interior or corner Iai STATE OF NEW YO~K~ t/ COUNTY OF .~',..~.//~... · befn~gt~uJTsworn, deposes and says that he ,s the apphc~.~, above named. He ,s the ......~d~'~r~"~'~ '~'~i~'~'~'~Z'~f~'¥ ................................................. of sa~d owJler or owners, and is duly authorized to perform or have performed the said work and to make ond this application, that ali statements contained in this application are true to the best of his knowledge and behef, ant that the work wdl be performed m the manner set forth m the application filed therewith Sworn to before me this ........ ........ Notary Publ,c~..~.~/ JUDITH T BOKEixl':~nty ..... (~'ig'~'~tur~' ~f a~~' '~-x-------~'''' '-' ~ojr~tV Rubric, Slate of New York ~, .~2-034~9c3 Suffolk Counly ~xpl~e$ M,~rch 30, r--